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ISSN: 2641-6859
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Year first Published: 2018
Language: English

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Level of Micronutrients in Elite Sports: Impact on Muscle Damage, Infections, Sleep Disorders and Fatigue

Klaus Erpenbach^1*, Max C. Erpenbach¹, Wolfgang Mayer², Uwe Hoffmann³, Stefan Mücke¹ 

¹Institut für medizinische Leistungsoptimierung und Trainingssteuerung, Marienstraße 1, 50374 Erftstadt, Germany
²Lab4more GmbH Bavariahaus, Augustenstraße 10, 80333 München, Germany
³Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933 Köln, Germany

Received Date: July 18, 2020; Accepted Date: July 24, 2020; Published Date: August 10, 2020
^*Corresponding author: Klaus Erpenbach, Institut für medizinische Leistungsoptimierung und Trainingssteuerung, Marienstraße 1, 50374 Erftstadt, Germany. Email: info@im-lot.org 

Citation: Erpenbach K, Erpenbach MC, Mayer W, Hoffmann U, Mücke S (2020) Level of Micronutrients in Elite Sports: Impact on Muscle Damage, Infections, Sleep Disorders and Fatigue. Adv Ortho and Sports Med: AOASM-127.

DOI: 10.37722/AOASM.20203

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Abstract
Summary: Muscle damage, recurrent and serious infections or exercise-induced fatigue especially to the end of the playing period in team sport or to the end of preparation for competition in endurance or single sport are the most common symptoms in elite sport demolishing optimal training results. Are micronutrient deficiencies responsible for these symptoms in elite sport.

Methods: In 111 elite athletes [male: 50 – female: 61 / soccer: 21 – field hockey: 62 – Olympics: 19 – tennis: 5 – motorsports (DTM-Formula1): 4] blood vitamin D, coenzymeQ10, vitamin B1-B2-B6-B12 and folic acid as well as selenium, ferrum and magnesium intraerythrocytary were determined. In all elite athletes the symptoms muscle damage, infections, sleeping disorder and fatigue were correlated. A Spearman-ranking coefficient of correlation, a chi-quadrat-test by Pearson and an independent t-test were used.

Results: In 51, 3% of all elite athletes (N=57/111) a vitamin D-deficiency (< 30 ng/ml), in 57% (N=61/107) a selenium-deficiency (< 121 µg/l), in 70% (N=77/110) a coenzymeQ10-deficiency (< 750 µg/l) and in 27,1% (N=19/70) a magnesium deficiency intraerythrocytary were established. In cases of young player (< 18) vitamin D and of young national player (U16-U21) ferrum intraerythrocytary compared to national A player were poorly supplied [vitamin D: 25,71 ± 9,58 ng/ml vs 35,87 ± 12,35 ng/ml (p=0,007) – ferrum: 407,13 ± 43,09 mg/l vs 460,29 ± 36,69 mg/l (p=0,018)]. Muscle damages (in 73% of all cases) significantly occurred in vitamin D deficiency    [29,13 ± 9,38 ng/dl vs 36,27 ± 12,09 ng/dl, p=0,005] and in coenzymeQ10 deficiency [623,31 ± 226,31 µg/l vs 732,93 ± 408,19 µg/l, p=0,039] more frequently. Comparing the settings of vitamin D 40ng/ml [27,50 ± 7,85 ng/ml vs 46,31 ± 6,71 ng/ml, OR=4,53, p=0,007] muscle damage were observed 4,53 times more frequent in the lower group, whereas the settings of vitaminB1-(thiamine) < 50 µg/l vs > 50 µg/l [36,45 ± 7,01 µg/l vs 63,24 ± 24,33 ng/ml, OR=0,38, p=0,045] showed muscle damage in 62% less frequent in the lower group. No significances were observed in infection, sleeping disorder or fatigue.

Conclusion: Independantly to the type of sports, except all b-vitamines, deficiencies of essential vitamins and trace elements in elite sports were observed. Vitamin D- as well as coenzymeQ10- deficiencies and vitaminB1- excess play an important and significant role developing muscle damages. Further studies preventing muscle damages, recurrent infections and fatigue by treating elite athletes with micronutrients to eradicate those deficiencies are necessary.

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Introduction
        Micronutrients – vitamins and trace elements – interact with each other. They are essential and are needed daily to optimally maintain all physiological body functions [1-2]. High training effort, tight schedule, unbalanced or incorrect diet, frequent travel and high psychological stress lead to a high consumption of these micronutrients during preparation, which in 12.9% of cases ends in injuries and in 9.2% in acute infections and leads to lack of training and cancellation of competitions [3-6]. In major events such as the Olympics, FIFA World Cup or IAAF, 9.6-14% of participants fail due to injury [5-13]. 5.4-8.9% of participants suffer from an acute infectious disease, twice as many in winters than in summer [5-13]. The most common acute infections occur in the upper respiratory tract (46%), 25% in the urogenital system, followed by 21% with gastrointestinal infections and 8% skin infections [5-13]. These infections could not be reduced by the “General guidelines for illness prevention in athletes” of the Olympic Committee [14].

        For the competitive athlete, micronutrients play a major role in energy production, blood and bone health and antioxidant radical protection [1-2]. The group of B vitamins (thiamine, riboflavin, niacin, pyridoxine, folic acid, cobalamin), coenzyme Q10 and minerals (iron, magnesium, zinc, selenium) are necessary for the mitochondrial oxidation of carbohydrates and fatty acids to energy (ATP) in the respiratory chain and essential for the competitive athletes to maintain their immense energy expenditure [1-2]. For the high turnover of red blood cells (oxygen transport) the athlete needs cellular iron, vitamin-B6, -B9 and -B12 [15]. Adequate calcium, magnesium, phosphate and vitamin D values ensure the maintenance of sufficient bone density and prevent stress fractures [15-17]. Various antioxidants (vitamin A-C-E, selenium, zinc) protect cells and muscle tissue from destruction training and competition-related free oxidative radicals, especially by optimizing the cellular selenium-dependent Glutathione peroxidase and zinc-dependent superoxide dismutase [15]. In taking isolated micronutrients (polyunsaturated fatty acids (PUFA), folic acid, calcium, and antioxidants) seems to reduce muscle injuries and infections [18].

        The degree of fatigue a top athlete is highly related to the quality of sleep and stress level in competition [19- 20]. The determination of stress parameters (neurotransmitters: cortisol, serotonin, melatonin) from saliva and urine seem to give first indications of therapeutic impact [20]. Serotonin regulates pain and mood, while melatonin is responsible for sleep induction and is considered a powerful antioxidant for the brain. These neurotransmitters are dependent on their formation on specific amino acids (phenylalanine, tyrosine, and tryptophan), B vitamins (especially pyridoxine) and magnesium [21]. Epidemiological, prevention or therapy studies are not known yet.

        The aim of this study is to evaluate the micronutrient status of top athletes of various sports and to evaluate possible interrelationship with fatigue, sleep disorders, susceptibility to infections and muscle injuries. Are there clear differences between deficiencies of these vitamins and trace elements and the athletes’ complaints measurable?.

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Methods
Attendee 

        111 top athletes from various sports (team sports: field hockey and soccer – individual sports: athletics, tennis, motorsports) were included in the study to optimize their performance. All participants gave their agreement and were evaluated according to a questionnaire (sleep disorders, fatigue, muscle injuries, susceptibility to infections). Fatigue was defined as morning fatigue and lack of drive despite 7-hour sleep. Muscle injuries included all medically confirmed muscle fiber tears such a muscle bundle tears and tendon muscle tears. Susceptibility to infection was defined as at least 2 medically confirmed viral and/or bacterial infections or more per annum. Sleep disorders included both difficulty falling-asleep (> 15min duration to sleep) and difficulty sleeping-through. In all athletes, vitamin B1 -B2 -B6 -B12, folic acid, vitamin D, intracellular iron-selenium-magnesium, and coenzyme Q10 were examined in the blood and correlated with the symptoms.

Vitamins B1 (Thiamine), B2 (Riboflavin), B6 (Pyridoxin) (EDTA blood) and coenzyme Q10 (Serum)

      The determination of the B vitamins B1 (thiamine), B2 (riboflavin), B6 (pyridoxin) from EDTA blood and Q10 in serum was performed by high performance liquid chromatography (HPLC) with commercial kits (Chromsystems, Gräfelfing, Germany) according to manufacturer’s specifications (B1 and B6 – Order No. 51052 / B2 – Order No. 37000 / Q10 – Order No. 68000). 

Vitamin B9 (Folic acid) and B12 (Cobalamin) (Serum)

        The determination of vitamins B9 (folic acid) and B12 (cobalamin) was performed according to the manufacturer’s specifications as a competitive immunoassay with an automated two-step procedure on the Labor mat Immulite-2000XPI of Siemens Healthcare, Erlangen, Germany (B9 – Order No. 6605868 / B12 – Order No. 6608026).

Vitamin D 25-OH (Serum)

        The quantitative determination of the absolute concentration of 25-OH vitamin D in the serum was performed according to the manufacturer’s specifications by using a direct competitive chemiluminescence immunoassay (CLIA) at the laboratory machine Liasion-XL of Diasorin, Dietzenbach, Germany (Order No. 310600).

Magnesium and Selenium (EDTA blood) 

        The determination of magnesium and selenium in whole blood was performed by atomic absorption spectrometry (AAS).

Iron (EDTA blood)

        The iron content in whole blood was determined by mass spectrometry with inductively coupled plasma (ICPMS). 

Statistical Analysis 

        The data were evaluated statistically with the IBM®SPSS® software 25. Spearman Rho was used to calculate the correlation between the different parameters. A Pearson chi-square χ² 4-field test was used to compare the frequency of symptoms and age groups, and the Odds Ratio (OR) was calculated. The 95% confidence interval (CI) was calculated according to

𝐾𝐼95% = exp [ln (OR) ± 1.96 √∑ 1 𝑓𝑖 ln(OR) ] .

        For 2-group mean value comparisons, a level test was performed to examine variance homogeneity followed by an independent T-test for homogeneous (P>0.1) or homogeneous variance with bilateral questions. For k>2 groups or for combined influences of the different patient groups and the respective symptoms, a one- or two factor variance analysis (ANOVA) was applied. Post-hoc mean values were equalized with the two-sided Sidak test. For p ≤ 0.05 the results were described as significant, for p ≤ 0.01 as highly significant.

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Results
         (Table 1) illustrates the characteristics of the study population. 73% of all top athletes complained about muscle injuries, 44% fatigue, 40% infections and 32% sleep disorders. Female athletes high significantly were worse supplied within trace cellular selenium (109 ± 26.01 vs. 125.4 ± 30.51 µg/l, p<0.0005), intracellular magnesium (1.3 ± 0.11 vs. 1.4 ± 0.13 mmol/l, p<0.024) and intracellular iron (403.6 ± 35.72 vs. 477 ± 31.1 mg/l, p<0.0005) respectively than their male counter-parts. In total population, the average value of selenium was 116.95 ± 29.08 µg/l (norm: 121 – 168 µg/l) and Q10 was 653.21 ± 289.58 µg/l (norm: 750-1200 µg/l) below the norm. Young national players U16-U18 significantly suffered 3-times more from muscle injuries than the A national players [86% (18/21) vs. 67% (18/27) – OR = 3.00; 95%CI: 1.50 – 4.50, p=0.022]. No differences were found in infections, fatigue and sleep disorders. The vitamin D value of 51.3% (57/111) of the athletes determined < 30 ng/ml, with 13.5% (15/111) having a vitamin D deficiency (< 20ng/ml) and 37.8% (42/111) having an inadequate vitamin D supply (> 20-30 ng/ml).

         (Table 2) shows the comparison of youth vs. adults. In contrast to adults, adolescents are more badly supplied with almost all micronutrients (except vitamin B9 = folic acid). For vitamin D (25.71 ± 9.58 ng/ml vs. 35.78 ± 12.35 ng/ml – p=0.007) (Figure 1) and intercellular iron (407.13 ± 43.09 mg/l vs. 460.29 ± 36.69 mg/l – p=0.018) the youth players respectively the young national players U16-U18 are significantly worse supplied compared to the A-national players. The percentage of youth players within sufficient or inadequate vitamin D supply was 64.4% (29/45), with 22.2% (10/45) youth players showing vitamin D deficiency (< 20 ng/ml) and 42.4% (19/45) showing in adequate vitamin D supply (20-30 ng/ml). As a result, youth players have a significantly 2.46-fold higher risk of developing vitamin D deficiency (29/45 vs 28/66, OR = 2.46, 95%CI: 1.67 – 3.24, p<0.023) and a 2.72-fold higher risk of developing intracellular iron deficiency (14/30 vs 9/37, OR = 2.72, 95%CI: 1.68 – 3.76, p<0.055) than adults.

        In (Table 3) the values of the athletes in a group comparison are divided into groups below and above international recommendations [15, 22-27] in correlation to the symptoms. Deficiencies of micronutrients showed no effect regarding to sleep disorders. The probability to fatigue only tends to rise by selenium deficiency (p=0,091). Q10-deficiency as well tends to raise the probability of infections (p=0,065). Muscle damage significantly develop to vitamin-d-deficiency (p=0,007) and vitamin-B1-excess (p=0,045), respectively, and tends to rise by vitamin-B6-excess (p=0,058).

Figure 1: Median Vitamin D-value (± standard failure) of adults vs. adolescents with (MD=yes) and without (MD=no) muscle damage. The sample size is shown in the lower edge of the bar. ANOVA-factors group and muscle damage were highly significant (* = p<0, 01).

Table 1: Micronutrients and symptoms: infection, muscle damage, fatigue, sleep disorder correlated to gender and sports.Table 2: Value of micronutrients comparing adults and youth.Table 3: Comparison of micronutrients less than the middle of standard against more than the middle of standard in terms of the symptoms.